Senior Provider Reimbursement Representative – National Remote

At United Healthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Senior Provider Reimbursement Representative is responsible for activities associated with developing programs, policies, and strategies to ensure that contracted rates and reimbursement policies are applied accurately for company affiliates. The Senior Provider Reimbursement Representative will support those who analyze claims, pre and post payment, to ensure contracts and reimbursement policies and procedures are priced accurately; review claim disputes to verify correct pricing and analyze claim inquiry data to determine root cause of errors;

recommend system changes, training and process improvements to prevent future errors; work with both internal and external customers to identify and resolve complex problems; assist company affiliates with initial deployment and ongoing support of systems and processes to leverage national network rates and policies.

There’s a heavy analytical aspect to this role, involving running, reporting, and importing metrics within MS Access. You’ll be expected to provide accurate and effective reasoning as you help drive fee schedule builds, reimbursements, configurations, and maintenance.

You’ll enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges.

• Participate on the Senior Repricing Committee and with special repricing projects.
• Cover stops loss rush repricing shifts as late as 9pm CT as assigned.
• Participate in macro development, testing and training for the team.
• Work with team members on challenging system processes for complex claims.
• Analyze team processes for workplace efficiencies.
• Team Lead duties daily – including rush email boxes, macro, team member question emails, and other duties as assigned by management.
• Review and recommend system changes on provider contracts that appear inaccurate in the NDB (UHC Provider Network Database).
• Prioritize and organize own work to meet agreed upon deadlines.
• High Dollar Methodology Reviews (Ticklers).

• High School Diploma/GED (or higher).
• 3+ years of experience with UMR CPS processes.
• 2+ years of experience with NDB, ppoONE, iCES and UHC claim pricing.
• 2+ years of experience analyzing and handling inquiries or escalated issues for UHC priced claims.
• 2+ years of experience with UHC provider contract.
• 2+ years of experience repricing HCFA or UB claims.
• Intermediate level of proficiency with Microsoft Office Suite (Word, Excel).

• Strong research and analytical skills.
• Strong interpersonal skills: ability or desire to learn how to run small group meetings.
• Strong business, written and oral communication skills.
• Ability to handle a fast-paced environment with pressure based on project deadlines.
• Organized and detail oriented.

For more information on our Internal Job Posting Policy, .Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.

The hourly pay for this role will range from $23.41 to $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Final date to receive applications:
This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

A…